Chronic Obstructive Pulmonary Diseases:Journal of the COPD Foundation

Volume 13, Issue 3 - 2026

Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation is an open access, peer-reviewed medical/scientific journal dedicated to publishing original research, reviews, and communications related to COPD. Following peer review and editorial acceptance, manuscripts are published online as quickly as possible as Articles in Press.  These accepted manuscripts are then aggregated into journal issues 6 times per year (January, March, May, July, September, and November) and made available to the COPD medical/research community at no charge, without a required subscription fee. The Journal is indexed by PubMed, PubMed Central, Scopus and Web of Science.

Original Research:

Implementation of 2023 Canadian Thoracic Society Guidelines for Single-Inhaler Triple Therapy Could Reduce Exacerbation and Mortality Rates in COPD: PROMETHEUS Canada

Mohit Bhutani, MD, FRCPC, FCCP1 Alan Kaplan, MD, CCFP(EM), FCFP, CPC(HC)2 Sheena Kayaniyil, PhD3 Kyla Jamieson, PhD3 Ross Ormsby, MD, PhD3 John Bell4 Prachi Bhatt, PharmD, MPH5 Jennifer Carioto, FSA, MAAA5 Bruce Pyenson, FSA, MAAA5

Author Affiliations

  1. Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
  2. Family Physician Airways Group of Canada, and University of Toronto, Toronto, Ontario, Canada
  3. Scientific Affairs, AstraZeneca, Mississauga, Canada
  4. BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
  5. Milliman, New York, New York, United States

Address correspondence to:

Mohit Bhutani, MD, FRCPC, FCCP
Division of Pulmonary Medicine
Department of Medicine
University of Alberta
Edmonton, Alberta, Canada
Phone: (780) 492-3739
Email: mohit.bhutani@ualberta.ca

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is the fifth leading cause of death in Canada. The Efficacy and Safety of Triple Therapy in Obstructive Lung Disease (NCT02465567) and Informing the Pathway of COPD Treatment (NCT02164513) randomized controlled trials demonstrated reduced exacerbations and all-cause mortality for patients with COPD on single-inhaler triple therapy (SITT). The 2023 Canadian Thoracic Society (CTS) COPD pharmacotherapy guidelines recommend triple therapy, and preferably SITT use, in patients with moderate to severe symptom burden and high future risk of exacerbations. The clinical impact of broader SITT use in Canada has not yet been studied.

Aim: We aimed to estimate the benefit of appropriate SITT use according to CTS COPD guidelines on mortality, exacerbations, and their corresponding costs in Canada.

Methods: We used a stochastic model using literature-derived characteristics (e.g., incidence, changes in COPD severity, treatment, mortality, and exacerbations) that simulated the Canadian COPD population. Patients were assigned percentage of forced expiratory volume in 1 second predicted levels, and their annual characteristics were modeled for 2025–2034 under 2 scenarios: “status quo” (current practice) and “increased SITT” (following CTS guidelines).

Results: Based on our simulated results for the flagged population, “Increased SITT” use over 10 years compared to current treatment reduced moderate and severe exacerbation rates by 23% and 12%, respectively, for a reduction of 159,000 severe and 2.81 million moderate exacerbations and reduced the all-cause mortality rate by 22%. In the flagged population alone, this reduction in exacerbations would equate to a savings of CA$3.9 billion over 10 years.

Conclusion: Appropriate use of SITT, informed by the 2023 CTS COPD guidelines, could lower mortality, exacerbation frequency, and their corresponding costs in patients with COPD.

Citation

Citation: Bhutani M, Kaplan A, Kayaniyil S, et al. Implementation of 2023 Canadian Thoracic Society guidelines for single-inhaler triple therapy could reduce exacerbation and mortality rates in COPD: PROMETHEUS Canada. Chronic Obstr Pulm Dis. 2026; 13(3): 184-194. doi: http://dx.doi.org/10.15326/jcopdf.2025.0687

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Clinical Significance of a Reduced Forced Expiratory Volume in 3 Seconds to Forced Expiratory Volume in 6 Seconds Ratio in Adults

Siman Liao, MD1* Juncheng Liang, MD1* Jie Ou, MD2 Ranxi Peng, MD3 Shiyu Zhang, MD4 Leheng Tang, MD4 Qiaorui Zhou, MD4 Yingtong Chen, MD4 Xiaozi Guo, MD1 Jingxian Chen, MD1 Qi Wan, MD5 Zihui Wang, MD, PhD5 Zhishan Deng, MD, PhD5 Yumin Zhou, MD, PhD5,6 Fan Wu, MD, PhD5

Author Affiliations

  1. The Second Clinical College, Guangzhou Medical University, Guangzhou, China
  2. State Key Laboratory of Respiratory Disease, Guangzhou Chest Hospital, Guangzhou, China
  3. The Third Clinical College, Guangzhou Medical University, Guangzhou, China
  4. The First Clinical College, Guangzhou Medical University, Guangzhou, China
  5. State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease and National Center for Respiratory Medicine and Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
  6. Guangzhou National Laboratory, Guangzhou, China
* Theses authors contributed equally to this work.

Address correspondence to:

Fan Wu, MD, PhD
The First Affiliated Hospital of Guangzhou Medical University
Guangzhou, China
Email: wu.fan@vip.163.com.
Yumin Zhou, MD, PhD
The First Affiliated Hospital of Guangzhou Medical University
Guangzhou National Laboratory
Guangzhou, China
Email: zhouyumin410@126.com

Abstract

Background: The forced expiratory volume in 3 seconds (FEV3) to forced expiratory volume in 6 seconds (FEV6) ratio is a novel spirometry measure that identifies early airflow abnormalities, but its long-term prognosis value in the general population remains unclear. We aimed to evaluate the long-term all-cause mortality risk among participants with a reduced FEV3/FEV6.

Methods: Data were obtained from the National Health and Nutrition Examination Survey cycles 1988–1994 and 2007–2012. Reduced FEV3/FEV6 was defined as an FEV3/FEV6 less than the lower limit of normal. Multivariable logistic regression was used to assess the relationship of reduced FEV3/FEV6 with comorbidities and chronic respiratory symptoms. The relationship between reduced FEV3/FEV6 and all-cause mortality was evaluated using Cox regression models. The nonlinear relationship between FEV3/FEV6 and all-cause mortality was assessed using restricted cubic splines. Subgroup analyses were conducted to validate the robustness of the relationship.

Results: Overall, 25,159 participants were enrolled in the 308-month median follow-up analysis, of whom 8.8% (2225/25,159) had reduced FEV3/FEV6. Participants with reduced FEV3/FEV6 exhibited increased risks of congestive heart failure, asthma, chronic bronchitis, emphysema, respiratory symptoms, and all-cause mortality risk (adjusted hazard ratio=1.23, 95% confidence interval: 1.13–1.34, P<0.001). The findings remained consistent across subgroups. A nonlinear U-shaped association was observed between FEV3/FEV6 and all-cause mortality, with the turning point at 1.04.

Conclusions: Participants with reduced FEV3/FEV6 had worse respiratory health outcomes, suggesting that FEV3/FEV6 can be used as a prognostic spirometry indicator.

Citation

Citation: Liao S, Liang J, Ou J, et al. Clinical significance of a reduced forced expiratory volume in 3 seconds to forced expiratory volume in 6 seconds ratio in adults. Chronic Obstr Pulm Dis. 2026; 13(3): 195-205. doi: http://dx.doi.org/10.15326/jcopdf.2025.0649

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Understanding COPD Patients’ Perspectives on Utilizing Strategies to Limit Their Exposure to Wildfire Smoke

Jimmy Yao, MD, MPH1 Caitlin M. Lydon, MPH1 Nina Pak, PhD1 Kathleen A. Daly, BS1 Mary Meyer, MD, MPH2 Nadia Hansel, MD, MPH3 Mark T. Dransfield, MD4 Stacey Alexeeff, PhD1 Andrea Altshuler, PhD1 Laura C. Myers, MD, MPH1

Author Affiliations

  1. Division of Research, Kaiser Permanente Northern California, Pleasanton, California, United States
  2. The Permanente Medical Group, Diablo Service Area, Walnut Creek, California, United States
  3. Department of Medicine, Johns Hopkins Medicine, Baltimore, Maryland, United States
  4. Division of Pulmonary/Critical Care, University of Alabama at Birmingham, Birmingham, Alabama, United States

Address correspondence to:

Laura C. Myers, MD, MPH
Kaiser Permanente Northern California
Division of Research
Pleasanton, CA 94588
Phone: (925) 433-3491
Email: Laura.c.myers@kp.org

Abstract

Background: A translation gap exists in how patients with chronic obstructive pulmonary disease (COPD) utilize mitigation strategies to limit exposure to wildfire smoke. This study examines patients’ points of view about barriers and facilitators of strategy uptake.

Methods: We performed semistructured, virtual interviews with members of Kaiser Permanente Northern California until thematic saturation. We recruited participants aged ≥65 in the lowest quartile of socioeconomic status because they are disproportionately exposed to air pollution with fewer resources to mitigate exposure. Qualitative analysis was performed using inductive and deductive approaches.

Results: Of 90,696 adults, we interviewed 31 in January 2025. Participants were racially and ethnically diverse (19% Black, 10% Hispanic, 3% Native American, 68% non-Hispanic White), from 10 counties. Three major themes were: (1) patients tended to get wildfire and air quality information from internet and smartphone apps, not clinical encounters, but expressed openness to receiving information from clinicians, (2) there appeared to be modifiable barriers to uptake of mitigation strategies, such as education and supplying equipment (e.g., masks, air cleaners), and (3) patients preferred real-time alerts sent to their phones from trusted sources, such as health care entities, to change their behavior during periods of poor air quality.

Conclusion: By understanding patients’ perspectives about their relationship with wildfire smoke, we gained practical information to begin designing interventions to protect patients’ health during periods of poor air quality.

Citation

Citation: Yao J, Lydon CM, Pak N, et al. Understanding COPD patients’ perspectives on utilizing strategies to limit their exposure to wildfire smoke. Chronic Obstr Pulm Dis. 2026; 13(3): 206-215. doi: http://dx.doi.org/10.15326/jcopdf.2025.0682

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Exploring the Impact of Financial Toxicity in COPD: A Qualitative Study

Sonal G. Mallya, MD, MHS1 Kaila Holloway, MD, MPH2 Cyd K. Eaton, PhD3 Michelle Sharp, MD, MHS1 Nirupama Putcha, MD, MHS1 Kristin A. Riekert, PhD1 Theodore J. Iwashyna, MD, PhD1 Michelle N. Eakin, PhD1

Author Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland, United States
  2. Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, United States
  3. Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland, United States

Address correspondence to:

Sonal Mallya, MD, MHS
5501 Hopkins Bayview Circle, 4th Floor
Baltimore, MD 21224
Phone: (617) 823-9347
Email: smallya1@jhmi.edu

Abstract

Background: Individuals with chronic obstructive pulmonary disease (COPD) often face direct and indirect medical costs from unplanned emergency department visits and hospitalizations for acute exacerbations, out-of-pocket expenses for inhaled bronchodilators, and income loss from disability. Yet financial toxicity, which describes the objective burden and subjective distress resulting from medical costs, has not been studied in COPD. Individual experiences of financial toxicity in COPD offer insight into challenges that may be unique to this population.

Methods: We conducted semistructured interviews with 30 purposively sampled individuals with physician-diagnosed COPD. Transcripts were analyzed using inductive coding by 2 independent coders, and codes and were categorized through thematic analysis.

Results: Thirty participants completed semistructured interviews, of whom 56% were women, 43% non-Hispanic White, and 43% non-Hispanic Black. The mean age was 69.5 years, and 24 (70%) had public health insurance only. Several themes emerged including: (1) the sources of material burden in COPD; (2) adjustments to disease management, such as medication nonadherence or foregoing treatments; (3) adjustments to financial planning, including both changes to day-to-day spending and disruptions in major financial plans; (4) emotional impact; and (5) communication with health care providers.

Conclusion: Our findings are the first, to our knowledge, to describe the impact of financial toxicity in individuals with COPD. Financial toxicity in COPD is common and may adversely impact disease self-management, financial self-management, and psychological well-being. Additional research is needed to examine its impact on patient-reported outcomes and to develop interventions to reduce its burden.

Citation

Citation: Mallya SG, Holloway K, Eaton CK, et al. Exploring the impact of financial toxicity in COPD: a qualitative study. Chronic Obstr Pulm Dis. 2026; 13(3): 216-226. doi: http://dx.doi.org/10.15326/jcopdf.2025.0712

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Clinical Characteristics and Health Care Resource Utilization Among Individuals Undergoing Alpha-1 Antitrypsin Testing in a Quaternary Health System

Drew D. Robinson, MD1,2,3 Chia-Ying Chiu, DrPH1,2 Jane I. Hampton, MD4 George M. Solomon, MD1,5 J. Michael Wells, MD, MSPH1,2,3,6

Author Affiliations

  1. Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
  2. Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, United States
  3. Alpha-1 Clinical Resource Center, University of Alabama at Birmingham, Birmingham, Alabama, United States
  4. Department of Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, Texas, United States
  5. Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama Birmingham, Birmingham, Alabama, United States
  6. Birmingham VA Health Care System, Birmingham, Alabama, United States

Address correspondence to:

Drew Robinson, MD
University of Alabama at Birmingham
Phone: (281) 683-6791
Email: ddrobinson@uabmc.edu

Abstract

Rationale: Alpha-1 antitrypsin deficiency (AATD) is a genetically inherited condition that can result in serious lung and liver disease. It is unclear whether testing for common alleles is sufficient or if testing for rare variants is helpful in identifying clinically significant disease.

Methods: A retrospective review was performed on adult patients who had alpha-1 antitrypsin phenotyping from January 2016 through December 2021. We recorded clinical characteristics and then grouped patients based on Pi*types: normal, Pi*Z-heterozygotes (Het), Pi*ZZ, Pi*S-Hets, and defined a Pi*Non-S/Non-Z group to include other identified Pi*types. Chi-square and Kruskal-Wallis tests were used for bivariate analyses, generalized linear models for modeling forced expiratory volume in 1-second (FEV1), and logistic regression modeling for health care utilization outcomes adjusted for race, age, and sex.

Results: A total of 1777 tests were ordered from January 2016 through December 2021. Testing identified 79.5% Pi*MM, 8.4% Pi*Z-Het, 8.4% Pi*S-Het, 3.3% Pi*Non-S/Non-Z, and 0.5% Pi*ZZ. FEV1 to forced vital capacity and FEV1 percentage predicted were lowest in the Pi*Non-S/Non-Z group compared to the other groups. The Pi*Non-S/Non-Z group had higher mean neutrophil lymphocyte ratio compared to the other groups (p=0.021), higher hospitalization for acute respiratory events (27.6%; p=0.019), intensive care unit utilization (15.3%, p=0.011), and death (25.4%, p=0.041) compared to the other groups.

Conclusions: AATD Pi*typing identified several allelic combinations not previously linked with clinical disease. Compared to other Pi*type groups, the Pi*Non-S/Non-Z group had impairments in pulmonary function, elevated inflammatory markers, higher health care utilization, and death. Our results underpin the need to explore relationships between rare allelic combinations and clinical outcomes.

Citation

Citation: Robinson DD, Chiu CY, Hampton JI, Solomon GM, Wells JM. Clinical characteristics and health care resource utilization among individuals undergoing alpha-1 antitrypsin testing in a quaternary health system. Chronic Obstr Pulm Dis. 2026; 13(3): 227-236. doi: http://dx.doi.org/10.15326/jcopdf.2025.0723

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Small Pulmonary Artery and Vein Volumes Independently Predict Oxygen Desaturation in Smokers

Anastasia K. A. L. Kwee, MD1 Wouter A. C. van Amsterdam, MD, PhD2 Firdaus A. A. Mohamed Hoesein, MD, PhD1 Leticia Gallardo-Estrella, PhD3 Jean-Paul Charbonnier, PhD3 Stephen M. Humphries, PhD4 Harm A. W. M. Tiddens, MD, PhD3 James D. Crapo, MD5 Richard Casaburi, MD, PhD6,7 Pim A. de Jong, MD, PhD1 David A. Lynch, MD4 Esther Pompe, MD, PhD1

Author Affiliations

  1. Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
  2. Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
  3. Thirona B.V., Nijmegen, The Netherlands
  4. Department of Radiology, National Jewish Health, Denver, Colorado, United States
  5. Department of Pulmonology, National Jewish Health, Denver, Colorado, United States
  6. The Lundquist Institute for Biomedical Innovation at Harbor, University of California Los Angeles Medical Center, Los Angeles, California, United States
  7. Division of Respiratory and Critical Care Physiology and Medicine, Torrance, University of California Los Angeles, Los Angeles, California, United States

Address correspondence to:

Anastasia K. A. L. Kwee, MD
University Medical Center Utrecht
Department of Radiology and Nuclear Medicine
HP: E01.132, P.O. Box 85500, 3584 CX Utrecht
The Netherlands
Phone: +31610077279
Email: A.k.a.l.kwee-2@umcutrecht.nl

Abstract

Background: Multiple factors affect oxygen levels in chronic obstructive pulmonary disease (COPD), including airflow limitation, emphysema, ventilation-perfusion mismatch, cardiac dysfunction, and pulmonary vascular remodeling. We investigated the association of small pulmonary vein and artery volume with oxygen saturation.

Methods: In the COPD Genetic Epidemiology (COPDGene®) study cohort, current and former smokers were characterized with questionnaires, spirometry, oxygen saturation measurements, and computed tomography (CT). On CT scans, small pulmonary vein and artery volume (diameter <1mm) were quantified with automated image analysis. Associations of small vein and artery volume with oxygen saturation and supplemental oxygen use were investigated with multivariable regression, correcting for body surface area, clinical (including emphysema, forced expiratory volume in 1 second percentage predicted, and coronary calcium), and technical covariates.

Results: A total of 8931 individuals were included with a mean age of 60.0±9.0 years. Of the participants, 52.7% were male. Half were current smokers (50.7%), and the number of pack years was 44.5±25.0. Median saturation was 97% (interquartile range 95%–98%), and 1040 (11.6%) participants used supplemental oxygen. Oxygen saturation decreased with 0.14% (-0.25, -0.03) (p=0.01) for 1mL/m2 each increase in vein volume and 0.15% (-0.21, -0.09) for artery volume. Oxygen users had higher small vein volume (3.01±0.61mL/m2) compared to those without oxygen (2.68±0.53mL/m2). Each 1mL/m2 increase in vein volume (adjusted odds ratio [OR] 1.51 [1.25, 1.84] p<0.001) and artery volume (OR 1.16 [1.02, 1.31]) was associated with more supplemental oxygen use.

Interpretation: In current and former smokers, higher small pulmonary vein and artery volume were associated with lower resting saturation and more supplemental oxygen use, independent of lung disease severity or technical parameters. This suggests a role for vascular remodeling in smoking-related disease.

Citation

Citation: Kwee AKAL, van Amsterdam WAC, Mohamed Hoesein FAA, et al. Small pulmonary artery and vein volumes independently predict oxygen desaturation in smokers. Chronic Obstr Pulm Dis. 2026; 13(3): 237-248. doi: http://dx.doi.org/10.15326/jcopdf.2025.0694

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Perspective:

Reconsidering Vitamin D Supplementation in Pulmonary Disease: The Case for Targeted Respiratory Delivery

Kevin D. Schichlein, PhD1 Ilona Jaspers, PhD2 M. Bradley Drummond, MD, MHS3

Author Affiliations

  1. Curriculum in Toxicology and Environmental Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  2. Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  3. Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Address correspondence to:

Ilona Jaspers, PhD
Department of Pediatrics
University of North Carolina at Chapel Hill
Chapel Hill, NC
Phone: (919) 966-8657
Email: ilona_jaspers@med.unc.edu

Abstract

Despite compelling epidemiological evidence linking vitamin D deficiency to adverse outcomes in chronic obstructive pulmonary disease (COPD), asthma, and cystic fibrosis, randomized controlled trials have consistently failed to demonstrate clinically meaningful benefits from oral vitamin D supplementation. This disconnect between observational associations and interventional evidence represents a significant paradox in pulmonary medicine. Recent meta-analyses have found limited protective or therapeutic effects of oral supplementation on exacerbation rates, lung function, hospitalizations, or quality-of-life measures. We propose that this therapeutic failure reflects not a lack of vitamin D's efficacy but rather a fundamental limitation in the route of delivery.

Oral vitamin D supplementation undergoes hepatic metabolism and systemic dilution before reaching respiratory tissues. High expression of cytochrome P450 family 24 subfamily A member 1, the vitamin D-inactivating enzyme, in pulmonary vasculature suggests that orally delivered vitamin D may be degraded before reaching the lung lumen. The respiratory epithelium possesses complete machinery for vitamin D activation, and vitamin D receptors are expressed throughout airway epithelial and immune cells, making direct pulmonary delivery mechanistically feasible. Preclinical studies demonstrate that nebulized or inhaled vitamin D reduces inflammation, protects epithelial barrier function, and improves lung function in murine models of respiratory disease without producing off-target systemic effects or hypercalcemia.

Direct lung delivery of vitamin D represents an unexplored therapeutic strategy that could transform management of chronic respiratory diseases, like COPD, by achieving local therapeutic concentrations while minimizing systemic exposure. Clinical trials investigating safety, dosing optimization, and efficacy are warranted.

Citation

Citation: Schichlein KD, Jaspers I, Drummond MB. Reconsidering vitamin D supplementation in pulmonary disease: the case for targeted respiratory delivery. Chronic Obstr Pulm Dis. 2026; 13(3): 249-254. doi: http://dx.doi.org/10.15326/jcopdf.2025.0713

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Brief Report:

Symptomatic Changes Associated With a Pharmacist-Led COPD Program

Edward C. Portillo, PharmD1,2 Steven Do, PharmD1,2,3 Scott Hetzel, MS4 Jennifer Nguyen1 Katelynn Cleveland, MS1 Cara Ray, PhD5 Jenna Vande Hey1 Pramit Maskey, MS6 Rena Steiger-Chadwick, MPH5 Lucas M. Donovan, MD, MS7 Dylan Erdelt1 Sarah Will, PharmD8 Michael Shawn McFarland, PharmD8 Heather Ourth, PharmD8 Michelle Chui, PharmD, PhD9

Author Affiliations

  1. School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin, United States
  2. Pharmacy Department, William S. Middleton Veterans Affairs Hospital, Madison, Wisconsin, United States
  3. University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  4. Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, United States
  5. Center for Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Veterans Administration Hospital, Hines, Illinois, United States
  6. Colorado State University, Fort Collins, Colorado, United States
  7. Seattle VA Medical Center, Seattle, Washington, United States
  8. Department of Veterans Affairs Clinical Pharmacy Practice Office, Washington, D.C., United States
  9. School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, United States

Address correspondence to:

Edward C. Portillo, PharmD
School of Pharmacy
University of Wisconsin-Madison
William S. Middleton Veterans Affairs Hospital
Madison, WI
Phone: (815) 378-1132
Email: edward.portillo@wisc.edu

Abstract

This article does not contain an abstract.

Citation

Citation: Portillo EC, Do S, Hetzel S, et al. Symptomatic changes associated with a pharmacist-led COPD program. Chronic Obstr Pulm Dis. 2026; 13(3): 255-261. doi: http://dx.doi.org/10.15326/jcopdf.2025.0716

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